• Maria-Alexandra Petre, David N Levin, Marina Englesakis, Jason T Maynes, Petros Pechlivanoglou, and Kazuyoshi Aoyama.
• From the Department of Pediatric Anesthesia, Montreal Children's Hospital, McGill University, Montreal, Quebec (M-AP), Department of Anesthesia and Pain Medicine, The Hospital for Sick Children (DNL, JTM, KA), Department of Anesthesiology and Pain Medicine, University of Toronto (DNL, JTM, KA), Library and Information Services, University Health Network (ME), Program in Molecular Medicine (JTM), and Program in Child Health Evaluative Sciences (PP, KA), SickKids Research Institute, Toronto, Ontario, Canada.
• Eur J Anaesthesiol. 2021 Nov 1; 38 (11): 1111-1123.

BackgroundEmergence delirium is a common complication in paediatric anaesthesia associated with significant morbidity. Total intravenous anaesthesia (TIVA) and intra-operative dexmedetomidine as an adjuvant to sevoflurane anaesthesia can both reduce the incidence of emergence delirium compared with sevoflurane alone, but no studies have directly compared their relative efficacy.ObjectiveThe study objective was to compare the effects of TIVA and dexmedetomidine on the incidence of paediatric emergence delirium.Study DesignThe current study is a systematic review and network meta-analysis (NMA) of randomised controlled trials.Data SourcesWe conducted a systematic search of 12 databases including Medline (Ovid) and Web of Science (Clarivate Analytics) from their respective inception to December 2020.EligibilityInclusion criteria were randomised controlled trials of paediatric patients undergoing general anaesthesia using sevoflurane, sevoflurane with dexmedetomidine or TIVA. Data were extracted by two reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and analysed using NMA methodology. Risk ratios and 95% credible intervals (CrI) were calculated for all outcomes [emergence delirium, postoperative nausea and vomiting (PONV), and time to emergence and extubation]. The protocol was registered with PROSPERO (CRD42018091237).ResultsThe systematic review returned 66 eligible studies comprising 5257 patients with crude median emergence delirium incidences of 12.8, 9.1 and 40% in the dexmedetomidine with sevoflurane, TIVA and sevoflurane alone groups, respectively. NMA indicated that compared with TIVA, sevoflurane with adjuvant dexmedetomidine decreased the incidence of emergence delirium without statistical difference (risk ratio 0.88, 95% CrI 0.61 to 1.20, low quality of evidence), but resulted in a higher incidence of PONV (risk ratio: 2.3, 95% CrI 1.1 to 5.6, low quality of evidence).ConclusionClinical judgement, considering the patient's risk factors for the development of clinically significant outcomes such as emergence delirium and PONV, should be used when choosing between TIVA and sevoflurane with adjuvant dexmedetomidine. These findings are limited by the low quality of evidence (conditional recommendation).Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

13 keywords...

hide…